Why is the cost of most things so high in Ireland?

[arbitron]

Are you suggesting that their income has dropped to a level at which they are now below the incomes of their UK counterparts? The FEMPI cuts to GP's were an average of 7.5% and yet the NAGP come out with "cuts up to 38%". At best that's a misrepresentation of the facts, or a lie as us plebs call it.

It is hard to know who is earning what when you are jumping between types and grades of doctor. We can only do comparisons of like with like, and you have been avoiding that. You are looking at a FEMPI cut from 2013 and ignoring the cumulative changes from 2009. If you pick and choose DoH statements but don't look at the whole picture then that is adding to the problem.

Talking about people being plebs is a distraction and an easy way to create a caricature of a convenient enemy, but it's not helpful. Sure you could be the Queen of England for all we know. You can't on the one hand rail against elitist doctors and on the other hand reinforce the divide by talking about "plebs". The 2 greatest patient advocates that I know are both consultants who grew up in wealthy households and would never use a word like that. Equally the greediest miser I ever met grew up in poverty in inner city Dublin and wouldn't see a patient if they didn't hand over the green first.

My point is that GP's, along with Hospital Consultants, want it both ways; lavish pay but outsource the heavy lifting to someone else.

The most productive approach in life is to assume good faith and work from there. If you see doctors (or other professionals) as out to gouge you then you will only create discord. It is very easy for people to dismiss an entire group - it's lazy thinking. If you sit back and look at how people talk about greedy civil servants, the lazy unemployed, "snowflake" students, greedy professionals, travellers, etc. then who is actually left in good standing? Everyone is part of some group, so a little perspective and generosity of spirit is required. Of course they want to be paid well, everyone does. It's a matter of personal opinion whether a consultant is worth e100 or e1,000 an hour.

Yes, but not a main factor.

You went from saying that it's not a factor to saying it's not a main factor. The report say it is a specific factor for 65%.

Yes, but they include the non-Irish doctors who trained here but never intended to stay here. I can't find figures on what percentage of students in TCD, RCSI, UCD etc are foreign but my experience 20 years ago was that in TCD the class was over one third foreign students who were never going to stay here. When the RCSI present the emigration figures without that caveat they are at best misrepresenting of the facts, or lying as us plebs call it.

Again, you are talking about lying and plebs. Just because you don't like the report or disagree with it doesn't make them liars. Yes, a percentage of graduates are from abroad, but that percentage is lower than ever. So in real terms, more Irish are graduating and more Irish are leaving.

Because of the dysfunctional nature of the medical industry.

This is vague assertion. What specific dysfunction?

Smear tests, Prenatal examinations, vaccines, postnatal examinations and all the other schemes that the HSE pays for which are delivered through GP's.

Can you furnish us with the reports that shows non-GMS GPs are making 6-figure sums from these?

There is no big answer; there are thousands of small answers. It would be great to see Doctors unions and Nurses unions (sorry, Professional bodies) offering solutions that don't center around their own pay or taking more money from the public to try to fill the bottomless pit..

There can't be an answer when you won't pose a problem statement. What is it that healthcare workers should be addressing?

Are you aware that trainee doctors until recently were working 36+ hour shifts on site, often with little or no sleep? That has been illegal since 2004 but it took a junior doctor strike for the HSE to capitulate in 2013 and agree to a maximum of 24 hours - which is still illegal but was accepted as a compromise. And the HSE is still breaking these rules. The major reason for the change was doctor welfare, but there was also huge concern for patient safety. Doctor salaries went down as a result, because the number of hours worked decreased. So there is a good example of doctors losing money to improve their working conditions and to improve patient safety.

Nurses also work very hard to look after patients and do many things outside of their pay grade and remit. The HSE is held together by the good will of its staff. I know a hospital manager who was lumped with a project that no-one said could be done and they were about to cancel a month's worth of surgical lists - but she worked 12 hours a day, 7 days a week for 3 months straight to get the project done on time so that no patient would be delayed. She got no overtime and even her boss didn't know she was doing it. I only know because I grilled her on how she was able to do 12 months of work in 1/4 of the time. Soon afterwards she was headhunted by a multinational to become a project manager on double her current salary but she didn't even consider it as she is totally committed to her job in the HSE. So not everyone is in it for the cash and not every manager in the HSE needs to be fired. Those are lazy arguments.

 

[Purple]

The most productive approach in life is to assume good faith and work from there. If you see doctors (or other professionals) as out to gouge you then you will only create discord. It is very easy for people to dismiss an entire group - it's lazy thinking. If you sit back and look at how people talk about greedy civil servants, the lazy unemployed, "snowflake" students, greedy professionals, travellers, etc. then who is actually left in good standing? Everyone is part of some group, so a little perspective and generosity of spirit is required.

People who describe themselves as Professionals and use their job title as a prefix to their name are putting themselves on that pedestal, nobody else is putting them there.

Of course they want to be paid well, everyone does. It's a matter of personal opinion whether a consultant is worth e100 or e1,000 an hour.

Or €50 an hour. It's supply and demand economics but if you can limit supply you can earn super normal profits, or get higher wages. That's economics 101.

Nurses also work very hard to look after patients and do many things outside of their pay grade and remit.

There are the same Nurses who used to take blood but won't now because their Union told them not to? The same Nurses who would let me wipe up some coke that my son has spilled o the floor but rather went and called a cleaner, taking 15 minutes to do so? Sure they work hard but that's not efficient and it certainly isn't flexible.

This is vague assertion. What specific dysfunction?

We have a young population, an average density of doctors and a high density of nurses per head of population but we have a terrible healthcare system. Despite that young population we have the second highest spend in per head in the OECD but the poorest outcomes. Does that sound functional to you?

What is it that healthcare workers should be addressing?

The day to day wastes and inefficiencies they see.

Are you aware that trainee doctors until recently were working 36+ hour shifts on site, often with little or no sleep? That has been illegal since 2004 but it took a junior doctor strike for the HSE to capitulate in 2013 and agree to a maximum of 24 hours - which is still illegal but was accepted as a compromise. And the HSE is still breaking these rules. The major reason for the change was doctor welfare, but there was also huge concern for patient safety. Doctor salaries went down as a result, because the number of hours worked decreased. So there is a good example of doctors losing money to improve their working conditions and to improve patient safety.

The treatment of junior doctors (as opposed to all NCHD's) was disgraceful and dangerous. If they really wanted to screw up their career making a mistake wasn't the worst thing they could do, no, getting the "wrong" Consultant out of bed in the middle of the night; they is the worst thing they could do.

So not everyone is in it for the cash and not every manager in the HSE needs to be fired. Those are lazy arguments.

I agree. The whole thing about "Front line Staff" is BS. Good management is essential for any organisation. That said if the structure is inefficient then the person working within that structure is inefficient. Being inefficient and not working hard is not the same thing. Looking at individuals misses the point; everyone who works in an organisation knows some of its weaknesses. Good management looks for a way of hearing those voices and creating the most efficient organisation possible. The outcome will mean a reallocation of resources. In effect that means lots of job losses and different people being hired in different areas. Will doctors and nurses vote for job losses, even if it's only a few? I think we all know the answer to that. Will the administrators and others like them vote for job losses? I think we all know the answer to that as well.
As for who is in it for the money; there are as many greedy doctors and nurses as administrators. Doctors and other "Front Line Staff" are no better or worse, honest or dishonest, hard working or lazy, than anyone else, be that other person a manager, administrator, solicitor, plumber or painter.

One in every 19 people who works in Ireland works for the HSE. When it is the worst value for money health service in the OECD and sucks up so much of our national resource (€16.4 billion out of total government expenditure of €68.7 billion, or 24 cents in every Euro spent) it is a major part of the answer to the question "why are things so expensive in Ireland".

 

[arbitron]

People who describe themselves as Professionals and use their job title as a prefix to their name are putting themselves on that pedestal, nobody else is putting them there.

Elites are enabled by the general population. As I said before, many people will refer to someone as Dr., Fr., or other honorifics even if you are blue in the face saying "Call me Jack". If you are talking about older doctors, yes they will use their title more, but younger docs in general don't care. The #hellomynameis campaign showed this.

Or €50 an hour. It's supply and demand economics but if you can limit supply you can earn super normal profits, or get higher wages. That's economics 101.

I wrote e100 to see if you would argue the actual point or focus on the number - talking about the e50 is a distraction. Who is limiting the supply? If the job is so lucrative a surgeon from the UK can easily set up a private practice in Ireland and rake in the money. But that isn't what happens, so the economics are off.

There are the same Nurses who used to take blood but won't now because their Union told them not to? The same Nurses who would let me wipe up some coke that my son has spilled o the floor but rather went and called a cleaner, taking 15 minutes to do so? Sure they work hard but that's not efficient and it certainly isn't flexible.

That is a straw man - there is no nationwide campaign for nurses to stop taking bloods. In fact the INMO agreed to nurses taking on more tasks, including bloods, to regain their time+1/6 pay. The process is very slow, and there is some obstruction, but it's improving. And there are no units where it has gone backwards. I can't comment on the spilled coke.

We have a young population, an average density of doctors and a high density of nurses per head of population but we have a terrible healthcare system. Despite that young population we have the second highest spend in per head in the OECD but the poorest outcomes. Does that sound functional to you?

We have a below average number of docs per head of population in most specialties, with waiting lists way beyond the OECD average. We don't have a terrible healthcare system, that is a dramatic statement. At worst it is below average value for money, but our outcomes vary from excellent to poor depending on the specialty. I agree that there is dysfunction, but you haven't given any specifics.

The day to day wastes and inefficiencies they see.

Instead of presuming that HSE employees are not bothered, it would be better to do some research before making blanket statements. For example, the Mater runs a lean academy to train healthcare staff how to improve processes and save money. The RCPI runs quality management and leadership courses. And so on. So staff are doing what you claim they are not.

The treatment of junior doctors (as opposed to all NCHD's) was disgraceful and dangerous. If they really wanted to screw up their career making a mistake wasn't the worst thing they could do, no, getting the "wrong" Consultant out of bed in the middle of the night; they is the worst thing they could do.

Well all NCHDs are by definition all junior doctors, so I'm not sure what you mean by that. I also don't know what you mean about calling consultants, etc. It doesn't sound like an objective or evidence-based argument.

I agree. The whole thing about "Front line Staff" is BS. Good management is essential for any organisation. That said if the structure is inefficient then the person working within that structure is inefficient. Being inefficient and not working hard is not the same thing. Looking at individuals misses the point; everyone who works in an organisation knows some of its weaknesses. Good management looks for a way of hearing those voices and creating the most efficient organisation possible. The outcome will mean a reallocation of resources. In effect that means lots of job losses and different people being hired in different areas. Will doctors and nurses vote for job losses, even if it's only a few? I think we all know the answer to that. Will the administrators and others like them vote for job losses? I think we all know the answer to that as well.
As for who is in it for the money; there are as many greedy doctors and nurses as administrators. Doctors and other "Front Line Staff" are no better or worse, honest or dishonest, hard working or lazy, than anyone else, be that other person a manager, administrator, solicitor, plumber or painter.

One in every 19 people who works in Ireland works for the HSE. When it is the worst value for money health service in the OECD and sucks up so much of our national resource (€16.4 billion out of total government expenditure of €68.7 billion, or 24 cents in every Euro spent) it is a major part of the answer to the question "why are things so expensive in Ireland".

It would have been helpful if you had given concrete examples of what to change and how. It is extremely difficult to motivate people to improve the HSE when they are under fire from people with no evidence to back up their claims. This is my last comment on it as it has totally taken over a thread that could be quite productive.

 

[Dan Murray]

....For example, the Mater runs a lean academy to train healthcare staff how to improve processes and save money.

Just a quick comment. Visited an old pal in the Mater last week - a mild-mannered and gentle soul. He was extremely disappointed with the standard of care. He felt that the staff were well-intentioned but rudderless (his precise words). His family members said that there seemed to be no one of seniority taking charge and that the quality of communication was awful.

Obviously, this is only the impression of one patient and his family. However, as I know them well and that they are measured folk, I would mark their words.

 

[Purple]

Elites are enabled by the general population. As I said before, many people will refer to someone as Dr., Fr., or other honorifics even if you are blue in the face saying "Call me Jack". If you are talking about older doctors, yes they will use their title more, but younger docs in general don't care. The #hellomynameis campaign showed this.

Fair enough.

I wrote e100 to see if you would argue the actual point or focus on the number - talking about the e50 is a distraction. Who is limiting the supply? If the job is so lucrative a surgeon from the UK can easily set up a private practice in Ireland and rake in the money. But that isn't what happens, so the economics are off.

People don't come for the same reason people are leaving; we have a dysfunctional healthcare system. In order to retain staff we pay them more than we do in other countries but that still doesn't compensate for the shortcomings of the system. In other words we over pay for a sub standard service.

That is a straw man - there is no nationwide campaign for nurses to stop taking bloods. In fact the INMO agreed to nurses taking on more tasks, including bloods, to regain their time+1/6 pay. The process is very slow, and there is some obstruction, but it's improving. And there are no units where it has gone backwards. I can't comment on the spilled coke.

They did take bloods for decades but then refused to do so in order to blackmail the HSE into paying them more.

We have a below average number of docs per head of population in most specialties, with waiting lists way beyond the OECD average. We don't have a terrible healthcare system, that is a dramatic statement. At worst it is below average value for money, but our outcomes vary from excellent to poor depending on the specialty. I agree that there is dysfunction, but you haven't given any specifics.

Out outcomes are well below average and our costs are well above average. That results in wasted money and wasted lives.
Why the constant push for specifics, but nothing to specific as to be anecdotal? When my car breaks down I know it is broken down. I don't have to know the causes in order to know it doesn't work.

Instead of presuming that HSE employees are not bothered, it would be better to do some research before making blanket statements. For example, the Mater runs a lean academy to train healthcare staff how to improve processes and save money. The RCPI runs quality management and leadership courses. And so on. So staff are doing what you claim they are not.

I run LEAN programs. One of the core measures is a reduction in staff numbers and/or an increase in output. Has the Mater increased the number of patients they treat while at the same time reducing the number of staff they employ? If total staff numbers have remained the same has there been a major redeployment of staff? You see you can't have LEAN without a high level of labour flexibility. There is a very low level of labour flexibility within the State sector as everyone is unionised.

Well all NCHDs are by definition all junior doctors, so I'm not sure what you mean by that. I also don't know what you mean about calling consultants, etc. It doesn't sound like an objective or evidence-based argument.

It's a stupid definition an misrepresents the truth of the situation. If you work in the hospital sector and don't know what I mean about calling consultants then I worry that you are totally out of touch.

It would have been helpful if you had given concrete examples of what to change and how. It is extremely difficult to motivate people to improve the HSE when they are under fire from people with no evidence to back up their claims. This is my last comment on it as it has totally taken over a thread that could be quite productive.

That's a cop out; the people doing the job are always the best people to talk to first about what should change.
The evidence is our high spend for low outcomes.

 

[PMU]

Mr Taylor in the Irish Times article does not refer to which Eurostat publication inspired his article but I think it was http://ec.europa.eu/eurostat/documents/2995521/8072361/2-15062017-BP-EN.pdf/fff33756-4460-4831-9915-4a8c101f2b56, which is based on http://ec.europa.eu/eurostat/statistics-explained/index.php/Comparative_price_levels_of_consumer_goods_and_services. In his article Mr Taylor cited rents, buying a house and childcare as expensive items that particularly hit younger age groups, but the Eurostat publication and the related survey refer to three specific price categories and I can't find renting, house buying and childcare therein. Anyway, you can check it yourself. I'm not saying they are not relatively more expensive in Ireland just that I don't see support for this in the Eurostat data.

In any event, inflation is Ireland is currently negative and has averaged about 1.2% since the crash in 2008. http://www.inflation.eu/inflation-rates/ireland/historic-inflation/cpi-inflation-ireland.aspx. So with inflation currently negative, if certain goods/services are increasing in price, and are presumably regarded as 'expensive', others must be falling in price (otherwise you have inflation). So consumer choice, i.e. whether you decide to buy or not buy a good/service that is increasing in price, to a large extent determines if something is 'expensive' or not.

Mr Taylor suggests insider lobbying; limited competition; state imposed costs and productivity as reasons for high native prices, but I'm certain we are not unique in Europe in these areas, and it would have been more enlightening if instead of jumping on the 'millennials are being screwed' bandwagon, Mr Taylor had suggested policy failure that contribute to high prices, i.e. what are we doing that others are not that leads to elevated price levels in Ireland.